Høgli June Utnes, Småbrekke Lars, Garcia Beate Hennie
Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway.
Pharmacoepidemiol Drug Saf. 2014 Sep;23(9):933-41. doi: 10.1002/pds.3640. Epub 2014 May 2.
BACKGROUND/PURPOSE: Community-acquired pneumonia (CAP) is a disease with high morbidity and mortality. Adherence to clinical practice guidelines (CPGs) in treatment of CAP is associated with favourable outcome. We aimed to develop and validate a medication assessment tool (MAT) to explore adherence to CPG recommendations in patients with CAP admitted to a Norwegian hospital. The tool is named MAT-CAP.
Sixteen quality indicators (QIs) based on local and international CPGs were developed. Content validity was explored in an expert panel using a two-round modified Delphi technique. QIs demonstrating content valdity were reformulated into review criteria forming the MAT-CAP. Feasibility and adherence to MAT-CAP were explored in a retrospective study using data from electronic patient records of CAP patients admitted to the University Hospital of North Norway Tromso during 2008. Reliability was explored using Cohen's kappa (ĸ) statistics for inter- and intra-observer agreements.
Content validity was demonstrated for 15 QIs covering areas as initial empirical treatment, microbiological diagnostics, pathogen specific treatment, dose adjustment according to renal function, switch from intravenous to oral treatment and treatment duration. Overall reliability was excellent with ĸ-values of 0.88 and 0.95 for inter-observer and intra-observer agreements, respectively. Overall applicability was 37.2%, and mean application times were 3.1 and 3.8 min for the two observers. Overall adherence to 812 criteria applied was 59% (range 0-100).
We have demonstrated content validity, feasibility and reliability of a 15-criterion MAT-CAP. Adherence results from applying MAT-CAP criteria pinpointed areas with good clinical performance and areas with improvement potentials.
背景/目的：社区获得性肺炎（CAP）是一种发病率和死亡率都很高的疾病。在CAP治疗中遵循临床实践指南（CPG）与良好的治疗效果相关。我们旨在开发并验证一种药物评估工具（MAT），以探究挪威一家医院收治的CAP患者对CPG推荐的遵循情况。该工具名为MAT-CAP。
基于本地和国际CPG制定了16项质量指标（QI）。通过两轮改良德尔菲技术在一个专家小组中探讨内容效度。将显示出内容效度的QI重新制定为审查标准，形成MAT-CAP。利用2008年期间挪威北部特罗姆瑟大学医院收治的CAP患者电子病历数据，在一项回顾性研究中探究MAT-CAP的可行性和遵循情况。使用科恩kappa（κ）统计量来探究观察者间和观察者内一致性的可靠性。
15项QI的内容效度得到了证明，这些指标涵盖了初始经验性治疗、微生物学诊断、病原体特异性治疗、根据肾功能调整剂量、从静脉治疗转换为口服治疗以及治疗持续时间等领域。观察者间一致性的κ值为0.88，观察者内一致性的κ值为0.95，总体可靠性极佳。总体适用性为37.2%，两位观察者的平均应用时间分别为3.1分钟和3.8分钟。对所应用的812条标准的总体遵循率为59%（范围为0 - 100）。
我们已经证明了15条标准的MAT-CAP的内容效度、可行性和可靠性。应用MAT-CAP标准得出的遵循结果明确了临床表现良好的领域和有改进潜力的领域。
